Spousal Involvement in the Workplace of Doctors: What Is Defined as Appropriate or Inappropriate

Background: Workers spend a significant amount of time in the workspace. Involvement of a spouse in a doctor’s workplace can take different forms and come with different intentions. Objectives: The survey aimed to determine the prevalence and extent of spousal involvement in physicians’ workplaces as well as the outcome of such involvement on doctor’ swell-being, productivity, and relationship with colleagues. Methods: This cross-sectional online survey on spousal involvement in the workplace of doctors was conducted among 83 responding doctors from July to August 2023. Results: Among the respondents, 60 (72.3%) had witnessed a doctor’s spouse being involved in the workplace. The most common reason for spousal involvement in the workplace was to protect the spouse from what they perceived as a threat 34 (54.0%). Spouse’s ignorance of boundaries in the workplace (OR: 6.09 (95% CI: 1.70, 21.79) P: 0.003) and exertion of control by the spouse (OR: 11.2 (95% CI: 2.26, 56.41) P: 0.002) were significantly associated with higher odds of inappropriate spousal involvement in the workplace, while expression of love for spouse with acts of kindness was significantly associated with a lowered odd of inappropriate spousal involvement (OR: 0.11 (95% CI: 0.03, 0.36) P: 0.0001). Conclusion: Spousal involvement in the workplace is relatively common. Ignorance of the boundaries of the workplace and exertion of control by the spouse were significant enablers of inappropriate spousal involvement in the workplace of doctors. The establishment of workplace policies that define the limits of spousal involvement in the doctor’s workplace can foster a healthy workspace environment, enhance doctors’ well-being, and improve patient care.

Appropriateness of Amikacin Dose Prescription, Monitoring and Safety during Hospitalization as an Impact of Clinical Pharmacologist Intervention, in the Israeli Regional Hospital

Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.

Examination of the Appropriateness of Teaching Materials for Preventing Dangers during Ablution and Bathing of Infants by Mothers and Family Members

Purpose: This study aimed to develop teaching materials to prevent the dangers of ablution and bathing infants, based on the dangerous experiences of mothers and family members, and examine their appropriateness. Methods: A total of 20 midwives and public health nurses were selected as participants. Teaching materials and anonymous self-administered questionnaires were distributed, and the participants were asked to view the teaching materials and fill in the questionnaires. Retrieval was done by mail. The teaching materials included digital content, such as videos, sounds, and characters, which incorporated dangerous situations, preventions, and innovations in ablution and bathing procedures. The analysis was conducted by simple tabulation for each survey item. The free description was coded to preserve anonymity. This study was conducted with the approval of the Research Ethics Review Board of the authors’ affiliated university. Results: The teaching materials were found to be appropriate in terms of suitability to purpose, degree of difficulty of content, ease of viewing the videos, validity of time, appropriateness of expression, and usability. Conclusions: Ablution teaching materials that are used at the present time do not focus on dangers, and to date, no resources on bathing have been used as teaching materials. The created teaching materials in this study can be viewed multiple times, and mothers and family members who are unfamiliar with ablution and bathing can acquire knowledge regarding dangers and danger prevention. The addition of specific preventive measures and countermeasures for the occurrence of danger, along with practice, would result in the development of further appropriate teaching materials to reduce danger and alleviate anxiety.

Transforming Molecules into Medicines: Role of CDMOS in Phase-Appropriate Technology Transfers in Advancing Pharmaceutical Innovation

CDMOs are emerging as critical drivers of innovation within the pharmaceutical and biotech industries. As the pharmaceutical industry continues to evolve, we can expect to see CDMOs play an increasingly important role in drug development and manufacturing. Many companies within these sectors are now leveraging the expertise of CDMOs through technology transfers to foster innovation and enhance the development of new drug products. In the extensive field of drug development, technology transfer plays a crucial role at multiple stages, ranging from preclinical phases to commercialization. By working closely with drug developers, CDMOs can ensure that technologies are transferred seamlessly between phases of drug development, allowing for a more efficient and cost-effective development process. CDMOs also bring a wealth of experience in various areas of drug development, including process development, analytical testing, quality control, and manufacturing. This expertise, combined with a focus on innovation, can help drug developers to overcome technical challenges and optimize their drug development programs. CDMOs can provide drug developers with various manufacturing capabilities, from small-scale clinical trials to large-scale commercial production. This flexibility allows drug developers to focus on their core competencies while relying on CDMOs to provide the necessary infrastructure and support for drug manufacturing. The critical role of CDMOs in advancing pharmaceutical innovation in phase-appropriate technology transfer where there will be a lot of effort and patience with strong technical expertise is required. This article explores the various types of Technology transfer from preclinical to commercial stages and successful strategies to foster innovation.

Study on Regionalization of High Efficiency Eco-agriculture in Eco-economic Zone of Poyang Lake

The high efficient eco-agricultural zone in Eco-economic Region of Poyang Lake was divided into three different areas. 12 indicators including per capita cultivated land,forest coverage,comprehensive utilization rate of straw,the ratio of the effective irrigation area to the arable land,amount of pesticide usage per unit area of arable land,the output value ratio of planting industry,the output value ratio of forestry and fruit industry,the output value ratio of stock farming,the output value ratio of fishery,the proportion of sown area of crop,proportion of sown area of oil plants and the proportion of sown area of vegetable were screened to construct the indicator system of regionalization of high efficient eco-agriculture. The average index values of the high efficient eco-agricultural regionalization of three regions were obtained,the development direction of the efficient eco-agriculture construction of three areas were analyzed according to the natural resources characteristics f eco-agricultural and requirements of high efficient eco-agricultural development of the regions.

Appropriate Garden Design of Primitive Ecology Based on the Indigenization of Environmental Ethics

The accelerating urbanization process leads to aggravated environmental problems, thus garden design which is a creative activity connecting human and nature has attracted much attention, and also garden designers have had to rethink about environmental ethics and morals. This study, from the perspective of environmental ethics, duly proposed the brand-new concept of 'appropriate garden of primitive ecology', proceeded from the orientation, form, value, theoretical basis, realistic significance, culture and consumption psychology of 'garden of primitive ecology', fully developed outstanding ecological wisdoms and morals in traditional Chinese garden culture, boosted garden designs to the environmental ethics level of eco-justice, to seek for the approach to 'garden of primitive ecology' with indigenous Chinese environmental ethic characteristics.

Tourism Development Strategy in Poyang Lake Eco-economic Area from the Perspective of Industrial Cluster

As a regional tourism development strategy, tourism industrial cluster can promote the core competitiveness of tourism industry in advantageous regions and the great-leap-forward development of regions with less-developed tourism industry. The conditions of forming tourism industrial cluster in Poyang Lake Eco-economic Area was analyzed, the development strategies for tourism industry from the perspective of industrial cluster was put forward.

The Experimental Research on the Classroom Teaching Mode of Appropriate Combination of Traditional Methods with the Multimedia Overhead Projector

Based on the constructivism, using the College English（new edition） CD-ROMs for classroom teaching as main media, this paper explores the feasibility of the classroom teaching mode of appropriate combination of traditional methods with the multimedia overhead projector. The new teaching mode proves to be successful in that it has greatly improved the students＇ ability to use English in an all-round way and has obvious advantages over the only traditional method.

Ways to Develop College Students' Awareness of Appropriateness in Oral Communication

Appropriateness is very important in oral communication.By analyzing the problems in oral communication,this article puts forward some efficient ways to raise college students’awareness of appropriateness in oral communication.

Appropriate Listening Materials in Business English Teaching

Business English is a branch of ESP(English for specific Purpose),which determines its vocational and professional orient and its focus on learning for reality,work and professions,so applying real and authentic content in Business English teaching is suggested to be helpful both in theory and in practice.However,compared with other L2 skills teaching,to some points,listening input turns out to be problematic and uncertain in terms of utilization and selection of authentic listening materials currently.This article tries to present the problems and analyze to what extent these problems can be tackled by suggesting some appropriate listening materials.

Study on Planning and Design Mode of Eco-agricultural Demonstration Base in Poyang Lake Eco-economic Zone

Guided by the Planning of Poyang Lake Eco-economic Zone, traffic and geographic conditions of the Eco-agricultural Demonstration Base in the study area were analyzed, and design principles proposed as "adaptation to local conditions, scientific planning, benign circulation and sustainable development". Detailed planning and design was interpreted from the perspectives of infrastructure planning and functional area planning. Specifically, infrastructure construction should focus on traffic design, water, power and gas supply design, and also architectural design; while functional areas should be gradually developed from south section to central and then north section. It was to establish a design and planning mode that can be widely applied.

Appropriate empirical antibiotic use and 30-d mortality in cirrhotic patients with bacteremia

AIM: To analyze whether prompt and appropriate empirical antibiotic(AEA) use is associated with mortality in cirrhotic patients with bacteremia. METHODS: A total of 102 episodes of bacteremia in 72 patients with cirrhosis were analyzed. AEA was defined as a using or starting an antibiotic appropriate to the isolated pathogen at the time of bacteremia. The primary endpoint was 30-d mortality. RESULTS: The mortality rate at 30 d was 30.4%(31/102 episodes). Use of AEA was associated with better survival at 30 d(76.5% vs 46.9%, P = 0.05), and inappropriate empirical antibiotic(IEA) use was an independent factor associated with increased mortality(OR = 3.24; 95%CI: 1.50-7.00; P = 0.003, adjusted for age, sex, ChildPugh Class, gastrointestinal bleeding, presence of septic shock). IEA use was more frequent when the isolated pathogen was a multiresistant pathogen, and when infection was healthcare-related or hospital-acquired. CONCLUSION: AEA use was associated with increased survival of cirrhotic patients who developed bacteremia. Strategies for AEA use, tailored according to the local epidemiological patterns, are needed to improve survival of cirrhotic patients with bacteremia.

Appropriate Strategies for Rural Houses In Northwest China

To avoid the old road of urban development with high consumption and high pollution,this paper took the houses in a village near Yinchuan(a typical city of Northwest China)as an exemplary project to explore the appropriate strategies in the arid cold climate for the sustainable development in rural undeveloped areas Northwest China.Firstly,all houses were designed according to the principles of passive solar heating.Secondly,optimized biomass energy technologies such as biogas pit and straw gasification stove were utilized for cooking or heating.Last but not the least important,the ecological building materials such as earth,straw bale,fly ash were used to construct houses,which improves the indoor thermal comfort and meanwhile lowers the negative impact on the environment.Low costs,easy accessibility and habitants' inclination were taken into account in the process of design.

Eco-economic evolution, emergy evaluation and policy options for the sustainable development of Tibet

As economies and ecological support systems become more interdependent, new disciplines are needed to 'bridge the gap' of understanding between societies and nature. It is now clear that neither ecology nor economics alone can address the problems of our global commons. New measures of wealth, of value, of contributions and production are needed that acknowledge the 'natural capital' and 'ecosystem services' provided from healthy environments. A new interface is now being recognized termed 'eco-economics'. It is an ambitious and necessary attempt to understand the affairs of humanity and nature as a single, interdependent system. New tools are being invested to measure wealth. services and production fairly and equitably. In this report we use systems analysis approach to study the combined ecological-economic system of Tibet We use an alternative measure of value, based on real contributions to system performance, termed EMERGY, spelt with an 'M'. It is an accounting unit of total contributions, direct and indirect. used in generating a product or service. It is a concept derived from understanding whole systems, their interactions and interdependence, and the resources driving and maintaining them. This broader approach will help us to investigate Tibetan resources utilization and potentialities and exchange. Emergy analysis allows comparison and incroporation of environmental costs and benefits with variables of traditional economic costs and benefits to provide a more comprehensive perspective for public policy directives. Through this research, we think: 1) China has made a great effort in making Tibet develop from a closed regional system to a more and more opened regional system which is very important to the sustainable development of Tibet. 2) The increase of economic development and population growth has a close relationship with the total emergy storage and use in transportation. Education in modern science and technology increased the shared emergy of Tibetans to modern science and technology and stimulated the process of matching material and energy imports from outside with local resources. 3) There is great potential to develop hydropower and geothermal reserves that may stimulate not only economic development but also the better use of environment. 4) The better trained population can increase the empower of Tibet eco-economic system. Future development needs all kinds of talent exchanges with the outside system to develop education. 3) Compared with the Tibet economic system, Taiwan economic system is much more competitive. GNP and emergy use are very useful functions for comparing the competitive power of different ecological economic systems.

Degree of coupling and coordination of eco-economic system and the influencing factors： a case study in Yanchi County, Ningxia Hui Autonomous Region, China

Based on the statistical data, we analyzed and evaluated the degree of coupling and coordination of the eco-economic system in Yanchi County for the period spanning from 1983 to 2014. The eco-economic system can be divided into socioeconomic and ecological sub-systems and their relationship can reveal the interaction state between the two sub-systems and help the local government to establish a coordinated development mode. An index system was constructed to assess the development of the two sub-systems before the evaluation of the degree of coupling and coordination. The principal component regression analysis was adopted to quantitatively assess the influences of natural, economic and social factors on the degree of coupling and coordination of the eco-economic system. Results showed that, from 1983 to 2014, the development trends of both sub-systems were increasing with the ecological sub-system having more fluctuations. The degree of coupling and coordination of the eco-economic system in the study area increased gradually from 1983 to 2014, but experienced five different development stages from the verge of disorder to favorable coordination. The development of the local social and economic conditions was the most important factor influencing the degree of coupling and coordination. The second most important factor was the financial support from the local government. In addition, the environment protection policies also played undeniable roles. Due to the diversity of the influence factors, the government should take comprehensive measures to promote the sustainable development of the eco-economic system.

Appropriateness of outpatient gastrointestinal endoscopy in a non-academic hospital

AIM:To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients.METHODS:In total,789 consecutive outpatients referred for gastrointestinal(GI) endoscopy [381 for esophagogastroduodenoscopy(EGD) and 408 for colonoscopy] were prospectively enrolled in the study.The American Society for Gastrointestinal Endoscopy(ASGE) guidelines were used to assess the relationship between appropriateness and the presence of relevant endoscopic f indings.RESULTS:The overall inappropriate rate was 13.3%.The indications for EGD and colonoscopy were,respectively,appropriate in 82.7% and 82.6% of the exams,uncertain in 5.8% and 2.4% and inappropriate in 11.5% and 15%.The diagnostic yield was signif icant higher forEGDs and colonoscopies judged appropriate and uncertain when compared with those considered inappropriate(EGD:36.6% vs 36.4% vs 11.4%,P = 0.004;Colonoscopy:24.3% vs 20.0% vs 3.3%,P = 0.001).Of the 25 malignant lesions detected,all but one was detected in exams judged appropriate or uncertain.CONCLUSION:This study shows a good adherence to ASGE guidelines by the referring physicians and a significant increase of the diagnostic yield in appropriate examinations,namely in detecting neoplastic lesions.It underscores the importance that the appropriateness of the indication assumes in assuring high-quality GI endoscopic procedures.

Appropriateness of indication and diagnostic yield of colonoscopy: First report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy

AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE).METHODS: A total of 736 consecutive patients (415males, 321 females; mean age 43.6±16.6 years)undergoing colonoscopy during October 2001-March2002 Were prospectively enrolled in the study. The 2000ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication.RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered'generally indicated'; it was 'generally not indicated' for20%, and it was 'not listed' for 16% in the guidelines.The diagnostic yield of colonoscopy was highest for the 'generally indicated' (38%) followed by 'not listed'(13%) and 'generally not indicated' (5%) categories.In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was 'generally indicated' (odds ratio=12.3) and referrals by gastroenterologist (odds ratio = 1.9).CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician's specialty. Certain indications 'not listed' in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines.

Research on Functional Characteristics of Karst Eco-economic Compound System in Guizhou Province

Based on the eco-economy theory,this paper analyzed the characteristics of the components of eco-economic compound system of karst region in Guizhou Province.The functional characteristics of eco-economic compound system of karst region in Guizhou Province were analyzed.The functional characteristics were as follows:low biological production of Guizhou Province;weak capacity of ecosystem;slow speed of storage and accumulation of material and serious environmental pollution;low production and efficiency of energy;serious wastes of energy.On the basis of functional characteristics of eco-economic compound System in Karst region.Some views in terms of maintenance and reconstruction of compound system,were put forward,including laying stress on improving ecological system;choosing and cultivating the advanced species that suit the Karst region;improving the amount and speed of material accumulation,at the same time,introducing into advanced production technologies and management experience;reducing the energy efficiency of each section in economic system and improving the transformation efficiency of energy.

Subaxial cervical spine injury classification system: is it most appropriate for classifying cervical injury?

The cervical spine injury represents a potential devastating disease with 6% associated in-hospital mortality （lain et al., 2015）. Neurological deterioration ranging from complete spinal cord injury （SCI） to incomplete SCI or single radiculopathy are potential consequences of the blunt trauma over this region. The subaxial cervical spine accounts the vast majority of cervical injuries, making up two thirds of all cervical fractures （Alday, 1996）. Few classifications （Holdsworth, 1970; White et al., 1975; Mien et al., 1982; Denis, 1984; Vaccaro et al., 2007） have been proposed to describe injuries of the cervical spine for several reasons. First, to delineate the best treatment in each case; second, to determinate an accurate neurological prognosis, and third, to establish a standard way to communicate and describe specific characteristics of cervical injuries patterns. Classical systems are primarily descriptive and no single system has gained widespread use, largely because of restrictions in clinical relevance and its complexity.

Complementary Zoning Frameworks for Sustainable Management of Eco-economic Capital:a Case Study of Lijiang,China

We propose two zoning frameworks for regional decision-makers to regulate eco-economic capital in Lijiang,southwest China,using an index system,layer overlay,and GIS spatial analysis.The frameworks include eco-economic zoning and major function-oriented zoning,with an emphasis on ecoeconomic capital and human activities.The two frameworks share common advantages in top-down resource regulation by a certain function and the pursuit of competitiveness,sustainability and welfare fairness.Their differences in development orientation,functional links and scale suitability provide a complementary approach for regional decisionmakers.The frameworks will help to understand complex eco-economic resource patterns and foster appropriate regional regulation strategies.